Maternity Module 9

Front 1

Risk factors during pregnancy

Back 1

maternal age under fifteen (going through own growth cycle, more likely for early labor, STDs, high blood pressure or anemia during pregnancy) or over 35 (C-sections or prlonged labor, genetic disorder)

maternal parity (5 or more pregnancies)

maternal ob/gyn history (2 or more spontaneous abortions, still birth, pelvic shape disorders, infection, NO PRENATAL CARE)

medical history (preeclampsia, multiple gestations, gestational diabetes, high blood pressure, diabetes, cardiac disease, lupus, multiple sclerosis, obesity, HIV, )

lifestyle (alcohol, drugs, smoking, poor nutrition, vegetarian diet)

genetics (defective genes inherited by the baby, chromosomal abnormalities resulting in spontaneous abortions, ABO incompatability)

Front 2

substance abuse in pregnancy

Back 2

below poverty level, exposed to violence, depression, low education, unmarryed, unemployed, involved in criminal justice system, highest in first trimester

smoking in white women are most common

smoking is going down, but alcohol and drug use in pregnancy are going up

most frequently missed diagnosis

typically do not seek prenatal care till later in pregnancy

15 states consider it child abuse

Front 3

heroin treatment

Back 3

methadone, behavioral, buprenorphine (linked to better treatment adherence with fewer side effects and overdoses than methadone), naltrexone (antagonist)

Front 4

pathophysiology of diabetes

Back 4

hyperglycemia results in decrease in insulin production or action, results in hypoosmolarity resulting in blood being more viscous drawing more intracellular fluid being drawn in, cellular dehydration, kidneys have to secrete more urine (polyuria), lead to excessive thirst (polydypsia), burn proteins and fats to compensate resulting in ketonuria and fat breakdown, starvation results making patient eat a lot (polyphasia), results in vascular changes resulting in heart, eye, and nerve ddamage

Front 5

four cardinal signs of diabetes

Back 5

polyuria, polydipsia, weight loss, polyphagia (from tissue breakdown)

Front 6

types of diabetes

Back 6

type I (10% of population, absolute insulin deficiency, autoimmune)

type II (most prevalent, 90% of population, insulin resistance, insufficient)

gestational diabetes (any degree of glucose intolerance recognized during pregnancy)

white's classification- age at diagnosis, duration of illness, end organ involvement,

assesses maternal and fetal risk (a-c are okay, d- t have poor pregnancy outcome due to already having vascular damage)

Front 7

physiological changes during pregnancy related to diabetes

Back 7

pancreas needs to produce more insulin because cells use more glucose, increase in glycogen storage

nausea and vomiting put them at risk for hypoglycemia,

2/3 trimester- glucose needs ot get to fetus, HPL and somatotropin cause insulin resistance to cause more blood to be available to cross over placenta

glucose levels in fetus are proportional to maternal blood stream, but does not cross placenta

Front 8

maternal risks with diabetes

Back 8

hydraminios, preeclampsia-eclampsia, hyperglycemia, ketoacidosis, cesarean delivery, increased susceptibility to infections, worsening retinopathy

Front 9

affects of diabetes to neonate

Back 9

congenital anomalies, cardiovascular, CNS, and skeletal system affected, increased size of fetus, macrosomia (resulting in birth injury), IntraUterine Growth Retardation (very small baby, diabetes with vascular involvement (decreased perfusion to placenta)), respiratory distress syndrome

Front 10

risk factors

Back 10

over 40, family history, prior macrosomic, malformed, or stillborn, obesity, PCOS, hypertension, glycosuria

Front 11

hemoglobin A1C

Back 11

level should be less than or equal to 6%

higher levels are highly correlated to fetal anomalies

shows how blood has been doing over 3 months period and more accurate than one that's from only a few hours

Front 12

Rh Alloimmunization

Back 12

occurs when a woman's immune system is sensitized to foreign erythrocyte surface antigens, stimulating the production of IgG antibodies,

when the protein is not htere, then they are Rh-. hemolytic anemic babies can occur if mom is Rh- and baby is Rh+

Front 13

indirect coombs test

Back 13

tests mother to see if she has been sensitized to Rh. antibody screen. Identifies antibodies that could be problematic for baby or mother if a transfusion is needed.

if father is positive and mother is negative, than you need to do testing

Front 14

ABO incompatibility

Back 14

mild hemolytic

from mothers with O blood type andd baby has A or B blood type.

mother has anti A and anti B antibodies in serum

no prophylactic treatment done.

monitored for hyperbillirubinemia and anemia

check baby for positive coombs test in which case you check for jaundice

Front 15

Group beta strep

Back 15

around 35-37 week gestation, need to be screened for colonization of this. GBS positive means they are given antibiotics after labor or ROM. decreases bacterial count that fetus is exposed to.

need to monitor for sepsis of the newborn

Front 16

preeclampsia types of hypertension

Back 16

leading cause of maternal mortality.

4 hypertensive classificiation

chronic (preexisting before preg.)

chronic with superimposed preeclampsia (preexisting and then develop preeclampsia)

preeclampsia-eclampsia

gestational hypertension (hypertension in pregnancy without preeclampsia symptoms)

Front 17

preeclampsia

Back 17

proteinuria, hypertension,

if after 20 weeks they develop proteinuria and hypertension it was believed they had preeclampsia

no longer requires proteinuria

occurs in about 5-10%

Front 18

pathophysiology preeclampsia

Back 18

only cure is delivery of the placenta which it is thought to be related to.

vasospasm and decreased perfusion to organs, increased cardiac output wihtout lowered vascular resistance leading to hypertension, decreased perfusion, endothelial dysfunction.

imbalance in hormones in placenta (vasodilator and vasoconstrictor: increase in prostacyclin and decrease in thromboxane) leads to vasoconstriction.

Front 19

vasospasm and decreased organ perfusion results in

Back 19

decreased perfusion to liver, kidney, placenta, and brain

resulting in failure, seizures, retinal issues/ detachment, hemolysis of red blood cells, low platelet count (DIC)

Front 20

mild preeclampsia

Back 20

women with hypertension of 140/90 after 20 weeks. with proteinurea.

mild is being discouraged because it is not really mild

instead called preeclampsia without severe features

Front 21

severe preeclampsia

Back 21

womenwith progressing symptoms. BP 160/110 or higher. proteinurea higher (3+)

multi organ failure, kidney and liver failure. increased liver enzyme secretions. CNS irritability

Front 22

risk factors for preeclampsia

Back 22

nulliparity, teensand older adults, african american, hispanic, lower socioeconomic status, family history, chronic hypertension, diabetes, lupus erythematosus, mulltigestation, trophoblastic disease, fetal hydrops

Front 23

symptoms that mean preeclampsia is getting worse

Back 23

increasing edema, scotomata, blurred vision, decreasing urinary output, epigastric pain, vomiting, bleeding gums, persistent or severe headache, neurologic hyperactivity, pulmonary edema, cyanosis

Front 24

eclampsia

Back 24

occurrence of seizure activity!!

can be different types of seizures

Front 25

magnesium sulfate

Back 25

used for CNS depressant to prevent seizures

need to check for alertness. can stop them from breathing. need to have antagonist available.

too much can cause depressant.

baby can have CNS depression too

need to check clonus and CNS freuently

Front 26

HELLP syndrome

Back 26

occurrs from breakdown of red blood cells

Hemolysis

Elevated Liver Enzymes

Low Platelet Count

Associated with severe preeclampsia

epigastric pain is primary symptom- from elevated liver enzymes

Front 27

ectopic pregnancy

Back 27

implants outside uterine cavity

occurs in 2% of pregnancy- 95% of them are in fallopian tubes (called tubal pregnancy)

Front 28

number one s/s of ectopic pregnancy

Back 28

unilateral pain in abdomen

Front 29

risk factors for ectopic pregnanc

Back 29

STIs or pelvic inflammatory disease, use of an IUD, IVF, endometriosis

Front 30

treatment of ectopic pregnancy

Back 30

salpingostomy (removal of tube), methotrexate (chemotherapy agent, targets rapidly dividing cells, monitor for blood loss, possible loss of fallopian tube and fetus

Front 31

molar pregnancy

Back 31

abnormal placenta from fertilization

cysts form instead of placenta

low protein intake, asian women, more than 35 years old.

complete molar is an empty egg fertilized by a sperm - avascular vessicles grow. 20% become malignant.

incomplete molar- normal ovum fertilized with polar spermy, lower incidence of malignancy

Front 32

s/s of molar pregnancy

Back 32

rapidly growing uterus, vaginal bleeding, nausea/ vomiting, hypertension, high levels of hCG, no fetal heart beat